Kambhampati Aparna, Meghani Kinza, Ndlovu Ntokozo, Monare Barati, Mutimuri Mercia, Bazzett-Matabele Lisa, Vuylsteke Peter, Ketlametswe Rebecca, Ralefala Tlotlo, Neugut Alfred I, Jacobson Judith S, Vulpe Horia, Grover Surbhi
School of Medicine, University of Texas at Southwestern, Dallas, Texas.
Department of Oncology, University of Zimbabwe, Harare, Zimbabwe.
Adv Radiat Oncol. 2023 Apr 24;8(5):101257. doi: 10.1016/j.adro.2023.101257. eCollection 2023 Sep-Oct.
The global rise in cancer incidence has been accompanied by disproportionately high morbidity and mortality rates in low- and middle-income countries. Many patients who are offered potentially curative treatment for cervical cancer in low- and middle-income countries never return to start treatment for reasons that are poorly documented and little understood. We investigated the interplay of sociodemographic, financial, and geographic factors as barriers to care among such patients in Botswana and Zimbabwe.
Patients seen in consultation between 2019 and 2021 who were >3 months late for an appointment to initiate definitive treatment were contacted via telephone and invited to complete a survey. Afterward, an intervention connected patients with resources and counseling to return for treatment. Follow-up data were collected 3 months later to ascertain the outcomes of the intervention. Fisher exact tests analyzed the relationship between the putative number and types of barriers and demographics.
We recruited 40 women who initially presented for oncology care but did not return for treatment at [Princess Marina Hospital] in Botswana (n = 20) and [Parirenyatwa General Hospital] in Zimbabwe (n = 20) to complete the survey. Overall, married women experienced more barriers than unmarried women ( < .001), and unemployed women were 10 times more likely to report a financial barrier than employed women ( = .02). In Zimbabwe, financial barriers and belief-associated barriers (eg, fear of treatment) were reported. In Botswana, many patients noted scheduling obstacles associated with administrative delays and COVID-19. At follow-up, 16 Botswana patients and 4 Zimbabwe patients had returned for treatment.
Financial and belief barriers identified in Zimbabwe showcase the importance of targeting cost and health literacy to reduce apprehensions. In Botswana, administrative challenges could be addressed with patient navigation. Improving our understanding of the specific barriers to cancer care could enable us to help patients who might otherwise default.
全球癌症发病率上升的同时，低收入和中等收入国家的发病率和死亡率高得不成比例。在低收入和中等收入国家，许多有望接受宫颈癌根治性治疗的患者因记录不详且鲜为人知的原因从未回来开始治疗。我们调查了社会人口、经济和地理因素之间的相互作用，这些因素是博茨瓦纳和津巴布韦此类患者获得治疗的障碍。
2019年至2021年期间前来咨询但预约开始确定性治疗迟到3个月以上的患者通过电话联系，并被邀请完成一项调查。之后，一项干预措施将患者与资源和咨询服务联系起来，以便他们回来接受治疗。3个月后收集随访数据，以确定干预措施的结果。Fisher精确检验分析了假定的障碍数量和类型与人口统计学之间的关系。
我们招募了40名最初前来接受肿瘤护理但未在博茨瓦纳的[公主玛丽娜医院]（n = 20）和津巴布韦的[帕里伦亚图瓦总医院]（n = 20）回来接受治疗的女性来完成调查。总体而言，已婚女性比未婚女性遇到更多障碍（P <.001），失业女性报告经济障碍的可能性是就业女性的10倍（P =.02）。在津巴布韦，报告了经济障碍和与信念相关的障碍（例如，对治疗的恐惧）。在博茨瓦纳，许多患者指出了与行政延误和新冠疫情相关的日程安排障碍。在随访中，16名博茨瓦纳患者和4名津巴布韦患者回来接受了治疗。
在津巴布韦发现的经济和信念障碍表明，针对成本和健康素养以减少担忧非常重要。在博茨瓦纳，可以通过患者导航来解决行政挑战。更好地了解癌症护理的具体障碍可以帮助我们帮助那些可能会放弃治疗的患者。
